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Introduction: People with multiple sclerosis (MS) are vulnerable to severe outcomes from COVID-19 infection and were prioritised for COVID-19 vaccination in Australia from March 2021. Despite this, vaccine hesitancy may hinder optimal vaccination uptake. Aim(s): This study explored COVID-19 vaccine uptake, beliefs, and hesitancy in people with MS. Method(s): People with MS receiving MS healthcare management at two Australian health services were invited to participate in an online survey, between September and October 2021. The survey collected sociodemographic and disease-specific characteristics, as well as vaccine status, vaccine hesitancy and beliefs towards COVID-19 vaccination using validated scales: the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six. Regression analyses were used. Result(s): Of the 281 people with MS (mean age 47.7 [SD 12.8] years;75.8% females) who participated, 82.9% had received >=1 COVID-19 vaccine dose. There were 17.1% who were unvaccinated, of which 51.2% reported they were likely to accept vaccination in future. Younger participants were less likely to be vaccinated (B[SE] 0.05[0.01]), as were those within 1-5 years disease duration (B[SE] -1.17[0.39]), all p<0.05. Compared to vaccinated participants, unvaccinated participants reported higher vaccine hesitancy (B[SE] 9.66 [0.72]), greater negative attitudes around vaccine complacency and confidence (B[SE] 13.36[1.40]), greater complacency toward COVID-19 in the context of MS (B[SE] 1.80[0.50]), and higher MS interaction concerns (B[SE] 3.38[0.52]), all p<0.001. Participants who reported no impact of MS on their daily life had lower concerns about the impact of COVID-19 vaccination on MS treatments or disease progression, compared with those reporting MS impacted their daily life all of the time (B[SE] -2.00[0.66], p=0.002). Conclusion(s): General and disease-specific COVID-19 vaccine concerns may influence uptake for people with MS. Understanding the reasons for hesitancy and how they correlate with MS disease and treatment interaction concerns may inform tailored education messages at individual and population levels that addresses these concerns, particularly for ongoing booster doses.
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Aims: Vaccination uptake is the principal focus of the world-wide response to the COVID-19 pandemic. Vaccine hesitancy remains a critical issue. Our aim was to ascertain rates and reasons for vaccine hesitancy in people with breast cancer (BC) in Australia. Method(s): Between June and October 2021, an anonymous online survey was conducted among people with solid organ cancer treated at nine Australian treatment centres. Data collected included demographics and clinical characteristics. Vaccine hesitancy and related beliefs were assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale (OCVCCS), and the Disease Influenced Vaccine Acceptance Scale-Six. Descriptive statistics, chi-squared and linear regression were used. Results for the BC subgroup are reported. Result(s): The BC subgroup (N = 986, mean age 58.4 years, 99% female) comprised 36.6% of the responses in the solid cancer population (N = 2691). Most (76%) were treated at metropolitan centres and 64% were receiving ongoing treatment. Early BC was more commonly reported than metastatic BC (77% vs. 23%). Overall, 82% self-reported at least one COVID-19 vaccine dose. Unvaccinated participants were more likely to diagnosed with BC for a shorter time (<2 years (22.1%) vs >=2 years (14.5%), p = 0.003). Participants with metastatic BC were more likely to be unvaccinated and report greater disease-related vaccine concerns and hesitancy, when compared with participants with early BC (all p < 0.05). When compared with participants with all other solid cancers, participants with BC reported more negative attitudes towards COVID-19 vaccine side-effects (OCVCCS Side-Effects subscale mean scores: 5.19 (SD 1.91) vs. 5.46 (SD 1.82), p < 0.001). Conclusion(s):Despite a relatively high rate of self-reported vaccination, people with BC reported lower vaccine confidence when compared with all other solid cancers. A better understanding of these inequalities, and strategies to address vaccine confidence in people with BC, particularly those with metastatic BC, should be developed.
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Aims: People with haematological malignancies (HM) are at increased risk of severeCOVID-19 infection and death due to underlying immune deficiency and impaired vaccine responses. FromMarch 2021,COVID- 19 vaccination was offered to patients with HM, as part of the Australian COVID-19 vaccination rollout program. This study sought to ascertain whether vaccine hesitancy was a barrier to optimal vaccine uptake and explored the attitudes of people with HM towards COVID-19 vaccination. Method(s): Between June and October 2021, an online survey was distributed to adults with HM at nine Australian health services. The survey collected sociodemographic and clinical characteristics, and attitudes towards COVID-19 and COVID-19 vaccination using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six (DIVAS-6). Result(s): Of the 869 survey participants (mean age 64.2 years, 43.6% female), 741 (85.3%) reported receiving at least oneCOVID-19 vaccine dose. Unvaccinated status was significantly associated with younger age, English as a non-dominant language, and shorter duration since diagnosis. Participants who were female or spoke English as their nondominant language reported more negative attitudes towards vaccine side-effects. Unvaccinated participants were more likely to report greater concerns about the vaccine impacting on their HM and treatment (DIVAS-6 Vaccine Vulnerability subscale score: B (SE) = 2.71 (0.35), p < 0.001). They were also more likely to report greater vaccine complacency (DIVAS-6 Disease Complacency subscale score: B (SE) = 1.79 (0.28), p < 0.001). Conclusion(s): People with HM reported high vaccine uptake, however, participantswho are recently diagnosed with malignancy, female, younger age or for whom English is a non-dominant language may benefit from targeted education strategies to address their vaccine concerns. Clinicians are well-positioned to address their patients' specific vaccine concerns and support the decision-making process, particularly with the need for COVID-19 vaccine boosters.
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Aims: Peoplewith cancer have increased morbidity and mortality associated with COVID-19 infection. The influence of a person's cancer diagnosis on COVID-19 vaccine uptake is not well understood. We undertook an in-depth exploration of factors influencing COVID-19 vaccine uptake among those with cancer. Method(s): Adults with cancer were recruited from nine Australian health services to undertake a cross-sectional online survey (June to October, 2021) covering COVID-19 vaccine uptake, vaccine hesitancy, confidence and complacency, and disease-related decision-making impact. Free-text responses were invited regarding thoughts and feelings about the interaction between the participant's cancer,COVID-19, and vaccination. Qualitative thematic analysiswas undertaken using an iterative process with representative verbatim quotes to illustrate the themes. Result(s): Of 3560 survey responses, 1248 (35.1%, mean age 62.7 (SD 11.8) years, 58.5% female) provided free-text comments for qualitative analysis. Participants who provided free-text comments were significantly less likely to have received a COVID-19 vaccination, compared to those who did not comment (31.4% and 68.6%, respectively). Five key themes were identified from qualitative analysis: (1) having a chronic illness heightened both perceived susceptibility to and severity ofCOVID-19;(2) disruption of cancer managementwas a significant perceived barrier to vaccination;(3) paucity of evidence on COVID-19 vaccine safety (for people with their cancer) compromised the perceived benefits;(4) fear of the unknown greatly reduced motivation to vaccine uptake and (5) many were left confused about COVID-19 and the vaccine. Conclusion(s): This analysis highlights the additional layer of complexity related to COVID-19 vaccination decision-making in people with cancer. An appreciation of higher susceptibility to severe COVID-19 outcomes is balanced against uncertain impact of the vaccine on disease progression and management. Clinician consultation that can address individualized concerns related to the person's cancer and treatments is important to alleviate concerns and maximize COVID-19 vaccine uptake in people with cancer.
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Introduction People with cancer are particularly vulnerable to COVID-19 and have been prioritised in vaccination programs. This group has reported concerns regarding the interactions between vaccines, cancer and anti-cancer treatments. We explored vaccine hesitancy in the disease-specific context of cancer Methods An online survey was conducted in Australia from June to October 2021. We developed a six-item scale assessing vaccine concerns in the context of chronic disease (Disease Influenced Vaccine Acceptance Scale DIVAS-6). Results There were 2691 evaluable responses;59% female, 71% from metropolitan areas, 36% with metastatic disease and 56% on current anti-cancer treatment. Commonest cancer types included breast 36.6%, genitourinary 18.6% and gastrointestinal 18%. Self-reported vaccine uptake was 80%. Overall, 57% agreed with the statement 'cancer makes me more worried about being infected with COVID-19.' Their doctor's recommendation regarding the vaccine was considered important by 79% of participants. 67% agreed with the statement that 'cancer means having the vaccine is more important.' This was different between vaccinated and unvaccinated participants (72% vs 46%). Unvaccinated participants had more concerns regarding vaccine efficacy (60% vs 34%), side effects (72% vs 29%) and interactions with anticancer treatment (53% vs 18%). Conclusions People with cancer have disease-specific concerns regarding COVID-19 vaccines. Use of DIVAS-6 can guide communication in this medically vulnerable population.
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Introduction Despite people with underlying comorbidities being particularly vulnerable to poor outcomes from SARS-CoV-2 infection, vaccine hesitancy remains problematic. There are no scales that measure disease or treatment-related vaccine concerns. Methods We developed a six-item scale assessing disease-related COVID-19 vaccine attitudes and concerns (The Disease Influenced COVID-19 Vaccine Acceptance Scale: DIVAS-6). A survey incorporating the DIVAS-6 was completed by 4683 participants with severe and/or chronic illness (3560 cancer;842 diabetes;281 multiple sclerosis). The survey included the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, demographic, diseaserelated and vaccination status questions. Results Six items were loaded onto two factors, disease complacency and disease-related vaccine vulnerability. Cronbach's alpha was 0.73 and 0.85 respectively. Measurement invariance analysis showed the two factors displayed psychometric equivalence across the patient groups. Each factor significantly correlated with the two Oxford COVID-19 Vaccine scales, showing convergent validity. The summary score showed good-to-excellent vaccination status discriminative ability (95% CI .77-.80). Conclusions This is the first validated scale measuring disease-related COVID-19 vaccine attitudes and concerns and should assist with guiding information delivery about COVID-19 vaccination in medically vulnerable populations.
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Introduction People with blood cancers are prioritised to receive COVID-19 vaccination. However, it is unclear how prevalent vaccine hesitancy is in this group. This analysis investigated vaccine uptake and vaccine hesitancy in people with blood cancers in Australia. Methods An online survey was conducted at nine health services in Australia from June to October 2021. Participant demographics and vaccination status were recorded. Vaccine hesitancy was assessed using the Oxford COVID-19 Vaccine Hesitancy Scale (OHS). Regression was used to examine whether clinico-demographic factors predicted the OHS score and vaccination status. Results Of the 869 participants, the mean age was 64.2 years, and 43.6% (n = 379) were female. A high proportion of participants had received at least one COVID-19 vaccine dose (85.3%, n = 741). Increasing age, speaking English as a first language, attending a regional health service, longer time since diagnosis and not currently receiving treatment were associated with being vaccinated. Participants who reported higher vaccine hesitancy were younger in age, more likely to have vocational qualifications and speak English as a second language. Conclusions There is a high rate of vaccination uptake in patients with blood cancers. However, younger patients and patients from culturally and linguistically diverse backgrounds appear to have lower vaccination uptake rates and higher levels of vaccine hesitancy. Tailored counselling may reduce the risk of adverse events due to COVID-19 infection.
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Background: People with cancer are at higher risk of serious illness and death from COVID-19 infection. We investigated the differences in COVID-19 vaccine uptake and attitudes in people with various solid organ and hematological malignancies. Methods: An online survey of adult patients with cancer attending eight health services across four states in Australia, was conducted from June to September 2021. Demographics, cancer history and vaccination status were recorded. Only completed surveys were analysed. Variables were compared with chi-squared and multivariable analysis using logistic regression. Vaccine hesitancy was assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford Vaccine Confidence and Complacency Scale, and the Monash Disease Vaccine Acceptance Scale. T-test analysis was used to examine relationships between the scales and groups. Results: There were 2997 evaluable responses;53.2% female, 61.8% from metropolitan areas, 27.5% with metastatic solid organ disease and 50.6% on current anti-cancer treatment. Patients with GI cancers comprised 13.5% (n = 405), compared with hematological 28.4%, breast 24.6%, genitourinary 14.1% and other cancer types 19.4%. Vaccination rates were significantly lower for respondents with GI cancers compared to other cancer types (71.6% v 79.3%;p< 0.001). Significant differences in the GI cancer population compared to all others were: more males (p < 0.001), lower level of education (p= 0.001), fewer reporting English as first language (p = 0.02) and shorter time since cancer diagnosis (p < 0.001). These remainedsignificant after logistic regression. Among GI cancer respondents, factors associated with being vaccinated compared to unvaccinated included: older age (p < 0.001), higher education level (p = 0.03) and English as first language (p = 0.01). There was no significant difference in the scales measuring vaccine hesitancy, confidence and complacency, for the GI cancer population compared to other cancers. As expected, there were significant differences in all scales comparing vaccinated to unvaccinated respondents with GI cancers. Conclusions: In our large, contemporary survey, Australians with GI cancers report lower COVID19 vaccine uptake compared with patients with other cancer types. We identified demographic and disease related characteristics that contribute to these differences. Interventions and targeted communication are required for people with GI cancers to maximise vaccination uptake in this medically vulnerable group.